Identification and management of hepatitis C patients in primary care clinics

Am J Gastroenterol. 2003 Mar;98(3):639-44. doi: 10.1111/j.1572-0241.2003.07331.x.


Objective: Previous survey-based research suggested that hepatitis C patients receive suboptimal care in primary care settings. The aim of our study was to define the actual level of care hepatitis C patients receive in primary care clinics.

Methods: Medical records of 229 hepatitis C antibody-positive (group 1), 229 hepatitis C antibody-negative (group 2), and 229 patients not tested for hepatitis C antibody (group 3) were reviewed to assess the indications for hepatitis C testing and the subsequent management and referral of hepatitis C antibody-positive patients diagnosed in primary care clinics. In addition, the compliance of primary care physicians with hepatitis C screening and testing guidelines was assessed.

Results: Only 16% of group 1 and 10% of group 2 patients were tested for hepatitis C based on physician-identified risk factors. Only 1% of group 3 patients had documented discussion of hepatitis C risk factors during their initial visit with a primary care physician. The majority of hepatitis C antibody-positive patients was appropriately evaluated in primary care clinics, and most (77%) hepatitis C RNA-positive patients with elevated liver enzymes were referred for subspecialty care. Of the 59 patients who underwent liver biopsy, 40% had bridging fibrosis or cirrhosis.

Conclusions: Hepatitis C testing is rarely initiated in primary care clinics based on physician-identified risk factors. Interventions should be developed to optimize early diagnosis of hepatitis C as significant liver disease may be present despite the absence of symptoms.

MeSH terms

  • Adult
  • Aged
  • Female
  • Guideline Adherence / statistics & numerical data
  • Hepacivirus / genetics
  • Hepacivirus / immunology
  • Hepacivirus / isolation & purification*
  • Hepatitis C / diagnosis*
  • Hepatitis C / drug therapy*
  • Hepatitis C / etiology
  • Hepatitis C Antibodies / blood
  • Humans
  • Male
  • Medical Records
  • Michigan
  • Middle Aged
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data*
  • Primary Health Care / statistics & numerical data*
  • RNA, Viral / isolation & purification
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors


  • Hepatitis C Antibodies
  • RNA, Viral